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Biol Psychiatry. 2015 Oct 1;78(7):505-14. doi: 10.1016/j.biopsych.2014.12.031. Epub 2015 Feb 7.

Impaired Recognition and Regulation of Disgust Is Associated with Distinct but Partially Overlapping Patterns of Decreased Gray Matter Volume in the Ventroanterior Insula.

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Department of Psychiatry, University of California San Francisco; San Francisco Department of Veterans Affairs Medical Center, San Francisco, California. Electronic address:
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
University of California San Francisco Memory and Aging Center, University of California San Francisco, San Francisco, California.
University of Pennsylvania, Philadelphia, Pennsylvania.
University of California Berkeley, Berkeley, California.



The ventroanterior insula is implicated in the experience, expression, and recognition of disgust; however, whether this brain region is required for recognizing disgust or regulating disgusting behaviors remains unknown.


We examined the brain correlates of the presence of disgusting behavior and impaired recognition of disgust using voxel-based morphometry in a sample of 305 patients with heterogeneous patterns of neurodegeneration. Permutation-based analyses were used to determine regions of decreased gray matter volume at a significance level p <= .05 corrected for family-wise error across the whole brain and within the insula.


Patients with behavioral variant frontotemporal dementia and semantic variant primary progressive aphasia were most likely to exhibit disgusting behaviors and were, on average, the most impaired at recognizing disgust in others. Imaging analysis revealed that patients who exhibited disgusting behaviors had significantly less gray matter volume bilaterally in the ventral anterior insula. A region of interest analysis restricted to behavioral variant frontotemporal dementia and semantic variant primary progressive aphasia patients alone confirmed this result. Moreover, impaired recognition of disgust was associated with decreased gray matter volume in the bilateral ventroanterior and ventral middle regions of the insula. There was an area of overlap in the bilateral anterior insula where decreased gray matter volume was associated with both the presence of disgusting behavior and impairments in recognizing disgust.


These findings suggest that regulating disgusting behaviors and recognizing disgust in others involve two partially overlapping neural systems within the insula. Moreover, the ventral anterior insula is required for both processes.


Disgust; Emotion recognition; Frontotemporal dementia; Insula; Neurodegeneration; Voxel-based morphometry

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